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pathophysiology > renal objectives 6-and like half of 7 (tests and problems) > Flashcards

renal objectives 6-and like half of 7 (tests and problems) Flashcards

1
Q

What do renal clearance tests measure?

A

They determine how much of a substance can be cleared from the blood by the kidneys in a given time.

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2
Q

What can renal clearance tests help evaluate?

A

They can indirectly measure GFR, tubular secretion, tubular reabsorption, and renal blood flow (RBF).

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3
Q

Why are renal clearance tests useful?

A
  1. Evaluating kidney function for diagnostic/prognostic purposes 2. Dosing certain medications (e.g., antibiotics) 3. Determining if a patient can undergo contrast imaging (like CT scans).
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4
Q

What is Blood Urea Nitrogen (BUN)?

A

A waste product from the breakdown of protein.

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5
Q

What is the normal serum range for BUN?

A

10-20 mg/dL.

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6
Q

What is creatinine a waste product of?

A

Normal breakdown of muscles and it is an estimate of GFR.

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7
Q

What is the normal serum range for creatinine?

A

0.7-1.2 mg/dL.

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8
Q

What is creatinine clearance?

A

The gold standard estimate of GFR, comparing creatinine levels in blood and urine.

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9
Q

What is the normal range for creatinine clearance?

A

90-120 mL/min.

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10
Q

What is included in a urinalysis?

A
  1. Glucose 2. Bilirubin 3. Leukocytes 4. Nitrites 5. Ketones 6. Proteins and blood 7. Casts 8. Urine pH 9. Urine specific gravity
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11
Q

What does bilirubin in urine indicate?

A

Excess bilirubin can indicate liver issues or breakdown of RBCs; it may turn the urine tea-colored.

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12
Q

What do leukocytes in urine indicate?

A

Increased levels suggest a possible infection.

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13
Q

What are nitrites in urine?

A

Chemicals produced from the conversion of nitrates by bacteria.

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14
Q

What do ketones in urine signify?

A

They indicate fat burning; they should not be present.

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15
Q

What do proteins and blood in urine indicate?

A

Possible glomerular damage.

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16
Q

What are casts?

A

Tiny particles made up of white blood cells, red blood cells, kidney cells, or substances like protein or fat.

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17
Q

What is the normal urine pH range?

A

4.6-8, with an ideal of 6.

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18
Q

What can alterations in urine pH indicate?

A

Increased risk of kidney stones.

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19
Q

What is the normal range for urine specific gravity?

A

1.001-1.005; high indicates concentrated urine, low indicates dilute urine.

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20
Q

What can alterations in urine concentration indicate?

A

Complications in the loop of Henle.

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21
Q

What is urinary tract obstruction?

A

A blockage of urine flow within the urinary tract.

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22
Q

What can cause urinary tract obstruction?

A

Anatomic or functional defects.

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23
Q

What factors determine the severity of urinary obstruction?

A
  1. Location 2. Completeness 3. Involvement of one or both upper urinary tracts 4. Duration 5. Nature and/or cause.
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24
Q

What is the significance of upper urinary tract obstruction?

A

It can lead to more severe complications since it is closer to the kidneys.

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25
Q

What are the complications of upper urinary tract obstruction?

A
  1. Hydroureter 2. Hydronephrosis 3. Ureterohydronephrosis 4. Tubulointerstitial fibrosis 5. Compensatory hypertrophy and hyperfunction 6. Postobstructive diuresis.
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26
Q

What is hydroureter?

A

Dilation of the ureters due to obstruction.

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27
Q

What is hydronephrosis?

A

Dilation of the renal pelvis and calyces due to obstruction.

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28
Q

What is ureterohydronephrosis?

A

Dilation of both the ureters and renal pelvis and calyces.

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29
Q

What is tubulointerstitial fibrosis?

A

Excessive deposition of collagen and proteins leading to excess cellular destruction and death of nephrons.

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30
Q

What is compensatory hypertrophy and hyperfunction?

A

A response that partially counteracts the negative consequences of unilateral obstruction.

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31
Q

What is postobstructive diuresis?

A

Fluid and electrolyte disturbances that occur when an obstruction is relieved.

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32
Q

What are kidney stones?

A

Masses of crystals, protein, or mineral salts that form in the urinary tract and may obstruct urine flow.

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33
Q

What are the main compositions of kidney stones?

A
  1. Calcium oxalate and calcium phosphate (70-80%) 2. Struvite (15%) 3. Uric acid (5-10%).
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34
Q

What are the risk factors for developing kidney stones?

A
  1. Male 2. Age (most develop before 50) 3. Inadequate fluid intake 4. Geographic location (temperature, humidity, food/fluid intake).
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35
Q

What mechanisms lead to kidney stone formation?

A
  1. Supersaturation of one or more salts 2. Precipitation of salt from liquid to solid state 3. Growth into a stone via crystallization.
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36
Q

How does urine pH affect kidney stones?

A

Alkaline urine can lead to calcium phosphate stones, while acidic urine can lead to uric acid stones.

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37
Q

What are the manifestations of kidney stones?

A
  1. Renal colic 2. Flank pain radiating to groin 3. Lower abdomen pain 4. Hematuria 5. Dysuria.
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38
Q

How is kidney stone diagnosis made?

A

Through history and physical examination (H&P), ultrasounds, and urodynamic tests.

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39
Q

What is neurogenic bladder?

A

Bladder dysfunction caused by neurologic disorders leading to problems with urine storage or voiding.

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40
Q

What occurs with upper motor neuron damage in neurogenic bladder?

A

Dyssynergia, which includes overactive bladder function and detrusor hyperreflexia.

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41
Q

What occurs with lower motor neuron damage in neurogenic bladder?

A

Detrusor areflexia, characterized by an underactive, hypotonic, or atonic bladder.

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42
Q

What are the manifestations of neurogenic bladder?

A
  1. Frequent daytime voiding 2. Nocturia 3. Urgency 4. Dysuria 5. Poor force of stream 6. Feelings of incomplete bladder emptying.
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43
Q

What are common causes of lower urinary tract obstruction?

A
  1. Anatomic obstructions 2. Urethral strictures 3. Prostate enlargement 4. Pelvic organ prolapse (e.g., cystocele).
44
Q

How is urinary tract obstruction diagnosed?

A

Through history and physical examination (H&P), imaging studies, and urodynamic testing.

45
Q

Upper motor neuron damage

A

Damage to neurons that originate in the brain and terminate in the spinal cord, affecting bladder control.

46
Q

Dyssynergia

A

Overactive or hyperreflexive bladder function due to upper motor neuron damage, resulting in poor coordination between bladder and sphincter.

47
Q

Detrusor hyperreflexia

A

Uninhibited or reflex bladder activity, leading to increased urinary urgency and frequency.

48
Q

Detrusor hyperreflexia with vesico sphincter dyssynergia

A

Condition where both the bladder and sphincter contract simultaneously, causing functional obstruction of the bladder outlet.

49
Q

Lower motor neuron damage

A

Damage to neurons that directly innervate the bladder, leading to impaired signaling.

50
Q

Detrusor areflexia

A

Underactive, hypotonic, or atonic bladder due to lower motor neuron damage, resulting in poor bladder contractions and retention of urine.

51
Q

What is the location of an upper urinary tract obstruction?

A

Ureters and renal pelvis

52
Q

What is the location of a lower urinary tract obstruction?

A

Bladder or urethra

53
Q

What causes upper urinary tract obstructions?

A

Anatomic or functional defects; kidney stones, tumors, strictures

54
Q

What causes lower urinary tract obstructions?

A

Anatomic defects; prostate enlargement, pelvic organ prolapse, urethral stricture

55
Q

How severe are upper urinary tract obstructions?

A

Generally more severe; can directly affect kidney function

56
Q

How severe are lower urinary tract obstructions?

A

Varies; can cause urinary retention but may not directly impact kidney function

57
Q

What are the complications of upper urinary tract obstructions?

A

Hydroureter, hydronephrosis, tubulointerstitial fibrosis, postobstructive diuresis

58
Q

What are the complications of lower urinary tract obstructions?

A

Urinary retention, bladder dysfunction, possible infection

59
Q

What are the symptoms of upper urinary tract obstructions?

A

Flank pain, renal colic, hematuria, dysuria

60
Q

What are the symptoms of lower urinary tract obstructions?

A

Frequent urination, urgency, nocturia, weak urine stream, feelings of incomplete emptying

61
Q

How are upper urinary tract obstructions diagnosed?

A

History & physical exam, ultrasound, urodynamic tests

62
Q

How are lower urinary tract obstructions diagnosed?

A

History & physical exam, imaging studies, urodynamic tests

63
Q

What are anatomic obstructions to urine flow?

A

Physical blockages in the urinary tract

64
Q

What can cause altered wound healing in the urinary tract?

A

Scarring that blocks or obstructs urine flow

65
Q

What is a urethral stricture?

A

Narrowing of the lumen due to infection, injury, or surgical manipulation

66
Q

What causes prostate enlargement?

A

Acute inflammation, benign prostatic hyperplasia, or prostate cancer

67
Q

What is pelvic organ prolapse?

A

Downward protrusion of pelvic organs, such as the bladder into the vagina (cystocele)

68
Q

What are the symptoms of anatomical obstructions?

A

Urinary retention, difficulty urinating, pain, or discomfort

69
Q

How are anatomic obstructions diagnosed?

A

History & physical examination, imaging studies

70
Q

What is the relationship between scarring and urinary tract obstruction?

A

Scarring can block or obstruct urine flow

71
Q

What complications can arise from urethral stricture?

A

Increased risk of urinary tract infections and bladder dysfunction

72
Q

How does prostate enlargement affect urine flow?

A

It can compress the urethra, leading to difficulty urinating

73
Q

What are renal adenomas?

A

Encapsulated benign tumors usually found in the renal cortex

74
Q

Can renal adenomas cause problems?

A

Yes, despite being benign, they can still lead to issues.

75
Q

What is renal cell carcinoma (RCC)?

A

The most common renal cancer, accounting for 85% of cases, arising from proximal tubule epithelial cells.

76
Q

What are some risk factors for renal cell carcinoma?

A

Tobacco use, obesity, and long-term analgesic use.

77
Q

What are early manifestations of renal cell carcinoma?

A

Often asymptomatic, but can include unexplained weight loss and fatigue.

78
Q

What constitutes the classic triad of renal cell carcinoma?

A

Hematuria, dull and aching flank pain, and a palpable flank mass (in thinner individuals).

79
Q

How is renal cell carcinoma diagnosed?

A

Through history & physical examination, ultrasound, X-ray/CT/MRI, and IV pyelography.

80
Q

What are the types of bladder tumors?

A

Papillary (attached to a stalk, tree-like growth) and non-papillary (more invasive with poorer prognosis).

81
Q

What are risk factors for bladder tumors?

A

Smoking and exposure to aromatic amines used in dyes and pharmaceuticals.

82
Q

What are common manifestations of bladder tumors?

A

Asymptomatic, hematuria, pelvic pain, and polyuria (frequent urination).

83
Q

How are bladder tumors diagnosed?

A

Through history & physical examination, cystoscopy, and transurethral biopsy.

84
Q

What is the most common pathogen causing urinary tract infections?

A

E. coli, responsible for 90% of UTIs.

85
Q

What are other pathogens that can cause UTIs?

A

Staphylococcus saprophyticus, Klebsiella, and Proteus.

86
Q

What is virulence in the context of uropathogens?

A

The ability to evade host defenses and cause disease.

87
Q

How do uropathogens adhere to the uroepithelium?

A

They form colonies that are hard to clear from the urinary tract.

88
Q

What ability helps uropathogens resist the host’s defenses?

A

The formation of biofilms that protect them from immune response.

89
Q

What are common manifestations of a UTI?

A

Asymptomatic, urinary frequency, dysuria, urgency, flank and/or suprapubic pain, cloudy and foul-smelling urine, fever, and chills.

90
Q

How is a UTI diagnosed?

A

Through history & physical examination, urinalysis, urine culture, and ultrasound.

91
Q

What urine culture result indicates a UTI?

A

Counts of 10,000/mL or more of specific microorganisms.

92
Q

What are some protective mechanisms of the urinary tract in women?

A

Mucus-secreting glands in the urethra trap bacteria.

93
Q

What protective mechanism do men have against UTIs?

A

The length of the male urethra and secretions from the prostate and periurethral glands.

94
Q

What role does the urethral sphincter play in preventing UTIs?

A

It acts as a mechanical barrier against infection.

95
Q

How does the immune system contribute to urinary tract protection?

A

It responds to fight pathogens in the bladder.

96
Q

What characteristics of urine help prevent pathogen survival?

A

Low pH and high osmolality of urea make it difficult for pathogens to survive.

97
Q

What are glycoproteins’ role in the urinary tract?

A

They create a slimy barrier that makes bacterial adherence difficult.

98
Q

How does dilute urine help prevent UTIs?

A

It washes bacteria away from the urinary tract.

99
Q

What is acute glomerulonephritis?

A

Inflammation of the glomerulus, often related to group A poststreptococcal infection.

100
Q

When does acute glomerulonephritis usually occur after infection?

A

Abrupt onset, usually 7-10 days post strep throat or skin infection.

101
Q

Who can be affected by acute glomerulonephritis?

A

It can occur in both adults and children.

102
Q

What is the mechanism behind acute glomerulonephritis?

A

Antibodies against the strep organism cross-react with glomerular endothelial cells, activating complement and immune cells, leading to glomerular dysfunction.

103
Q

How does acute glomerulonephritis affect GFR?

A

It leads to a decreased glomerular filtration rate (GFR).

104
Q

What happens to glomerular perfusion due to inflammation?

A

There is a decreased glomerular perfusion (blood flow) as a result of inflammation.

105
Q

What changes occur in the glomerular basement membrane?

A

There is thickening of the membrane, but increased permeability to proteins and red blood cells (RBCs).

106
Q

What are common manifestations of acute glomerulonephritis?

A

Hematuria (with red blood cell casts), proteinuria (>3-5 g/day with albumin), hypoalbuminemia, edema, decreased GFR, and potentially oliguria and hypertension in severe cases.

107
Q

How is acute glomerulonephritis diagnosed?

A

Through history & physical examination (H&P), urinalysis, serum creatinine, and creatinine clearance tests.

pathophysiology (56 decks)

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